Transcript Slide 1

SmartSense PPO Plans
POPULAR PLANS!
March 2009
SmartSense Highlights
 Reliable protection with some of our lowest monthly rates
 In-network office visits available before deductible
 Choice of prescription drug benefits
(Generic Only or Comprehensive)
 4TH quarter deductible carry-over
 $7 million lifetime maximum benefit
 2-year anniversary date rate guarantee on $5000 deductibles
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SmartSense Benefits
In-Network
Out-of-Network
4 OPTIONS
Deductible
Individual/Family
$500/$1,000
$1,500/$3,000
$5,000/$10,000
$2,500/$5,000
$5,000/$10,000
• Separate in-network and out-of-network deductibles
• Embedded (family) deductible
A member may meet the individual deductible before the rest of the
family and go into coinsurance, OR two or more family members can
meet the family deductible.
• 4th Quarter deductible carry-over feature
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SmartSense Benefits
Coinsurance
Annual OOP Maximum
Individual/Family
In-Network
Out-of-Network
30%
50%
$2,500/$5,000
$10,000/$20,000
(in addition to deductible)
Lifetime Benefit
Maximum
$7 million
• Separate in-network and out-of-network OOP Maximum
• Embedded (family) OOP maximum
A member may meet the individual OOP maximum before the rest
of the family and move into full coverage, OR two or more family
members can meet the family OOP maximum.
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SmartSense Benefits
Physician Office
Visits
In/Outpatient
Hospital Care
In-Network
Out-of-Network
$30 copay for first 3 visits
50% coinsurance after
out-of-network
deductible plus all
excess charges
then in-network deductible
and 30% coinsurance
30% coinsurance after
in-network deductible
Maternity
OP: All charges except
$380/day
30% coinsurance after
in-network deductible
50% coinsurance after
out-of-network
deductible plus all
excess charges
Not Covered
Not Covered
Emergency Care
additional $100
co-pay per ER visit
(waived if admitted)
IP: All charges except
$650/day
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SmartSense Benefits
In-Network
Annual Physical Exam
OR
HealthyCheck Center
30% coinsurance after innetwork deductible
$27/$75 copay for
basic/premium screening
(deductible waived)
Routine Mammogram
Routine Pap Smear & PSA
Routine Colorectal Cancer
Screenings
Out-ofNetwork
30% coinsurance after
in-network deductible
50%
coinsurance
after out-ofnetwork
deductible plus
all excess
charges
Preventive Care &
Immunizations for
Children (Birth to 6 years)
• 3 office visits before deductible
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SmartSense Benefits
In-Network
Out-of-Network
Ambulance Services
30% coinsurance after
in-network deductible
50% coinsurance* after
out-of-network deductible
Acupuncture/
Acupressure
Not Covered
Not Covered
Chiropractic Care
30% coinsurance after
in-network deductible,
$500 limit
50% coinsurance* after
out-of-network deductible,
$500 limit
Outpatient
Speech/Physical/
Occupational Therapy
30% coinsurance after
in-network deductible,
$2,500 limit
50% coinsurance* after
out-of-network deductible,
$2,500 limit
*Plus all excess charges
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SmartSense Benefits
Choose your Pharmacy Benefit!
 Generic Rx Only
 Comprehensive Rx
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SmartSense Benefits
Pharmacy Benefits
Generic Rx Only
In-Network
Out-of-Network
Generic
Drugs on
Generic Rx
Formulary Only
$15 co-payment or
40% coinsurance
(member pays
whichever is greater)
$15 co-payment or
40% coinsurance
(member pays
whichever is greater)
Brand Name
Not Covered
Discount Available
Not Covered
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SmartSense Benefits
Pharmacy Benefits
Comprehensive Rx
Generic
Brand Name
In-Network
Out-of-Network
$15 co-payment or
40% coinsurance
$15 co-payment or
40% coinsurance
(member pays whichever is greater)
(member pays whichever is greater)
$500 annual brand-name/
specialty deductible, then
$500 annual brand-name
deductible, then
$15 co-payment or 40%
coinsurance
(whichever is greater)
$15 co-payment or 40%
coinsurance
(whichever is greater)
2-member
maximum on
deductible
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SmartSense Benefits
Pharmacy Benefits
Comprehensive Rx
Generic
Brand Name
Specialty Drugs include
injected, infused, oral
and inhaled medications
that generally need
to be closely monitored
by the member’s doctor.
In-Network
Out-of-Network
$15 co-payment or
40% coinsurance
$15 co-payment or
40% coinsurance
(member pays whichever is greater)
(member pays whichever is greater)
$500 annual brand-name/
specialty deductible, then
$500 annual brand-name
deductible, then
$15 co-payment or
40% coinsurance
(whichever is greater)
$15 co-payment or
40% coinsurance
(whichever is greater)
40% of negotiated fee for
Specialty Drugs and
self-administered
injectables, except insulin
40% of negotiated fee for
self-administered injectables,
except insulin
No Specialty Drug Coverage
$4,500 annual OOP Maximum
The most a member would have to pay.
This is in addition to the brand deductible.
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Selling SmartSense
 One of our lowest priced plans with solid protection
that covers the essentials
 In-network office visits available before deductible
 $500 - $5,000 range of deductibles
 Embedded deductible and OOP maximum
 Choice of prescription drug benefits
(comprehensive or generic only)
 Lifetime maximum benefits of $7,000,000
 4th Quarter deductible carry-over
 2-year anniversary date rate guarantee on $5000
deductibles
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Questions?
Thank you!
The SmartSense plans are offered by Anthem Blue Cross Life and Health Insurance Company. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and
Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association.
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